1049. Improving Antibiotic Prescribing for Ambulatory Patients with Sinusitis
Steven J Bernstein, MD, MPH, VA Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System and University of Michigan, M Doud, University of Michigan Medical Center, RN Harrison, University of Michigan, C Standiford, University of Michigan

Objectives: To evaluate the effectiveness of a program to reduce non-recommended antibiotic use for patients with sinusitis.

Methods: Quasi-experimental study comparing antibiotic prescribing before (1/2000-6/2001) and after (7/2001-12/2002) distributing physician-specific antibiotic prescribing data. During the latter period a natural experiment occurred when one department permitted academic detailing and a second did not. Data were collected on 4153 and 3820 managed care patients with sinusitis in the two periods, respectively, who were treated by 112 physicians working in 14 Family Medicine and General Medicine out-patient clinics of an academic health care system. Antibiotics were classified as recommended (trimethoprim/sulfamethoxazole, amoxicillin), second-line alternatives (e.g., amoxicillin/clavulanate, cefuroxime) and not recommended (e.g., azithromycin) according to the institution's sinusitis guideline. To control for time-trends, we assessed antibiotic prescribing for upper respiratory infection for which there were no guidelines. Diagnoses were obtained from encounter forms and antibiotics from a managed care organization's pharmacy files.

Results: Antibiotics were prescribed to 67% of patients with sinusitis before physician specific feedback and to 57% of patients after feedback (p<0.001). Similarly, antibiotic prescribing for URI decreased from 20% to 14% (p<0.001). The use of non-recommended antibiotics for sinusitis decreased from 24% to 15% among physicians receiving feedback and academic detailing (p<0.001) and from 11% to 8% among physicians who received feedback only (p=0.09).

Conclusions: While academic detailing was associated with reduced use of non-recommended antibiotics it had no significant impact on overall prescribing.

Impact: Careful evaluation of guideline implementation projects is necessary to avoid falsely attributing success to a program.